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Phase 3b > Paedatrics > Flashcards

Paedatrics Flashcards

1
Q

What is impetigo?

What is a major RF for it?

A

Impetigo is a skin infection that is caused by a staph or a strep infection. It is very common in young children, highly infectious.

Major RF is pre existing skin disease already like eczema

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2
Q

What are the two types of impetigo?

A

Non Bullous (the more common form. You get the typical honey coloured rash etc)

Bullous: looks thinner more ulcerative. tends to be in the perianal, torso and limbs

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3
Q

What is the classical clinical presentation of impetigo?

A

You get runny nose, a bit itchy. crusty honey coloured lesions. Generally more obvious on the face. Auto inoculation to other areas.

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4
Q

How do you treat/manage impetigo?

A

You give antibacterial cream.
Get rid of nasal carriage by nasal cream
V infective so don’t go to school.

Moderate/severe: may need systemic or IV abx

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5
Q

What is Measles?

Is it a notifiable disease?

A

Is a RNA virus

Yes it is a notifiable disease

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6
Q

How can you remember the presentation of Measles?

A 
The 4 Cs 
Cranky 
Coryza 
Conjunctivitis 
Cough

You also have a rash that spreads from the ears through the rest of the body.
And Koplik spots on buccal membrane
Fever

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7
Q

What are 3 complications of measles?

A

pneumonia
encephalitis
deafness

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8
Q

What is the scientific name for croup?

A

laryngotracheobronchitis

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9
Q

How does croup present?

A

It presents mostly in young children 6 months to 6 years.

Generally fever and coryza beforehand.

Barking cough, hoarseness. That is worse at night.

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10
Q

What is the organism that causes croup?

A

Parainfluenza virus

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11
Q

How do you treat croup?

A

You treat it with dexamethasone
Steroid Nebs

If v bad give Nebs Adrenaline and Oxygen.

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12
Q

If you suspect croup but they have lots of airway secretion? What is the most likely diagnosis and how do you treat this?

A

Pseudomembranous Croup

Management IV abx and intubation

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13
Q

What are the two phases of whooping cough called? And what symptoms are shown in each phase?

A
  1. Catarrhal phase: 1 week of coryza symptoms
  2. Paroxysmal phase: coughing phase followed by the characteristic whoop. Here the child can go red/blue in the face and mucous can flow out of their nose/mouth.

Presentation can be via apnoea or sub conjunctival haemorrhage as well.

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14
Q

How would you diagnose whooping cough?

A

You would do a perinasal swab and see marked lymphocytosis on a FBC

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15
Q

How would you treat whooping cough?

Do you need to contact trace?

A

Erythromycin

Yes. Give erythromycin to all contacts

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16
Q

What are two likely causative organisms in peri-orbital cellulitis?

A

S Pneumoniae

H Influenzas

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17
Q

What additional tests do you need to do in orbital cellulitis?

A

CT scan to exclude infection

LP to exclude meningitis

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18
Q

What is the causative organism of epiglottis ?

A

H influenza

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19
Q

What age is epiglottis common in?

A

It is common in children aged 1-6 yrs

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20
Q

What symptoms are common in epiglottis?

A
  • High Fever, ill looking
  • Painful throat. Sat forward. Inspiratory stridor.
  • Saliva running down face.
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21
Q

How do you manage someone with epiglottis?

A

Need to secure the airway

Abx cefuroxime

Need to give prophylaxis to the entire household.

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22
Q

What is the treatment of candida/nappy rash in children?

A

You can give barrier cream/ointment (as prevention)

Steroid Cream +/- Anti fungal cream

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23
Q

What foods can cause a listeria infection?

A

Sprouts
Deli meats
Unpasteruised milk
Soft cheese

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24
Q

What are some of the symptoms/complications of having a listeria infection?

A

Symptoms: spontaneous abortion, meconium staining of liquor, neonatal sepsis, preterm delivery.

Then complications include sepsis, meningitis and pneumonia

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25
Q

What antibiotic do you give in listeria infection?

A

Penicillin

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26
Q

is listeria gram +ve or -ve ?

A

Gram positive

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27
Q

What is treatment pathway for symptomatic TB?

A

Rifampicin
Isoniazid
Pyrazinamide
Ethambutol

All 4 for 4 months
Then R + I for the remaining 2 months.

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28
Q

If asymptomatic for TB what is the treatment?

A

Rifampicin and Isoniazid

for 3 months

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29
Q

What type of pathogen is Rubella?

Is it notifiable?

A

It is a RNA Virus

It is a notifiable disease

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30
Q

How does rubella present?

A

You get a macular rash and sub occipital lymphadenopathy.

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31
Q

What are the complications of Rubella in utero?

A

Exposed in the first 4 weeks you get eye malformations

weeks 4-8 you get cardiac deformity

8-12 weeks= deafness

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32
Q

What is the most common cause of Otitis Media?

A

The most common cause is viral i.e. RSV or rhinovirus

Bacterial causes include S pneumoniae and H influenzae

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33
Q

What are 3 complications of otitis media?

A
  • Mastoiditis
  • Meningitis
  • Glue Ear
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34
Q

What is Perthe’s Disease?

A

This is when you get avascular necrosis of the femoral head

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35
Q

What are some RF for Perthe’s Disease?

A

More common in Males
Age 1-8
Mostly caucasian

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36
Q

How does Perthe’s disease present?

A

Pain in the hip or knee
Antalgic Gait
10-15% is likely to bilateral

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37
Q

What investigations are necessary for Perthe’s Disease?

A

You need to do FBC, ESR/CRP
X Rays
MRI arthrogram

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38
Q

What is the management of Perthe’s Disease?

A

You can do physio

Not any good? Do surgery

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39
Q

What factors are low in Von willebrand’s Disease?

A

you have low levels of factor 7 and vWF

40
Q

What does the clotting screen of someone with VWD look like?

A

normal or APTT may be slightly increased

41
Q

What is the diagnostic method of choice for Cystic Fibrosis in young children?

A

Sweat Test or via newborn heel prick test with immuno-reactive trypsinogen (IRT)

42
Q

What is the diagnostic method of choice for CF in older children/adults?

A

Genetic Testing

43
Q

What is the treatment for someone with CF?

A

So there is no treatment for someone with CF.

You just need to manage the symptoms:

Pancreatic insufficiency: give Creon and supplements/high calorie diet.

Prophylactic abx, anti fungals etc
Patient needs 2x daily physio and regular FEV measured

44
Q

What is seen on the blood work of someone with Haemophilia A?

A

You will see

Low Factor 8 and prolonged APTT

45
Q

How do you treat haemophilia A?

A

You give them prophylactic infusions of factor 8

If an acute bleed occurs give Factor 8, desmopressin and anti-fibrinolytic

46
Q

How do you treat haemophilia B acutely?

A

Factor 9 infusion
Anti-fibrinolytic
Desmopressin

47
Q

What are 3 common organisms that cause encephalitis?

A

HSV
EBV
CMV
VZV

48
Q

What are two bacterial causes of encephalitis?

A

TB
Malaria
Secondary to meningitis

49
Q

What is the triad presentation for encephalitis?

A

Altered mental state
Headache
Fever

can also have focal neurological deficits

50
Q

What are two infections you want to do for encephalitis?

What will they show?

A

LP which will show high lymphocytes. Send for PCR + culture and sensitivity

MRI head

51
Q

what is the management of encephalitis?

A

Acyclovir

Anti seizure medication (primidone)

52
Q

What is the stages for spot develop in chicken pox? (4 stages)

A

macule
papule
vesicle
crust

53
Q

What is the aetiology of retinoblastoma?

A

Inheritable via recessive inheritance

Non inheritable via mutation

54
Q

What is the presentation of retinoblastoma?

A

The presentation of retinoblastoma is generally leukocoria of one of the eyes. You can then get irritation of that eye (localised redness etc).

Issues with seeing and a squint may develop.

Can get CNS involvement and also if v progressed external swelling.

55
Q

How do you diagnose a retinoblastoma?

A

Ophthalmoscope

MRI scan to look at the underlying structures

56
Q

How do you treat the retinoblastoma?

A

Cryotherapy
Photocoagulation
Radiotherapy/ Chemotherapy

If v advanced enucleation

57
Q

How is prader willi syndrome inherited?

What chromosome is affected?

A

Maternally

Chromosome 15

58
Q

What is the presentation of prader willi at birth?

A

Hypotonia
Poor feeding
Sleepiness
Failure to thrive

Generally blue eyes and blonde hair

59
Q

What is the presentation of prader willi in toddlers?

A

Developmental Delay
Growth restriction
Behaviour and Learning difficulties
Excessive appetite due to too much Ghrelin

60
Q

How do you manage prader willi syndrome?

A

You manage PW syndrome by dietician review and controlling food consumption

61
Q

What is Edwards Syndrome?

A

Trisomy of chromosome 18

second most common trisomy behind Downs Syndrome

62
Q

How does Edwards Syndrome present?

A

Wide spaced nipples
Rocker bottom feet
Clenched fists
Microcephaly
Heart congenital abnormalities i.e. ASD or VSD
Deformed ears, cleft lip/palate or small mouth/jaw

63
Q

What is Klinefelter’s Disease?

What conditions are at increased risk with this condition?

A

When a patient has XXY

Breast Cancer
Osteoporosis
Diabetes Mellitus
Autoimmune Conditions

64
Q

How does Klinefelter’s Disease present?

A

It presents through being very tall, wide hips, gynaecomatasia, sparse facial and pubic hair

infertility and minor delay in learning/developmental issues

65
Q

Is Wilm’s Tumour an inherited condition?

A

Yes.

It is also a form of kidney cancer. If a child is high risk of developing a tumour. Do regular US scans.

66
Q

What is nocturnal enuresis?

When does it generally stop?

A

This is when you have bedwetting with no control at night.

Due to a lax sphincter. SO is generally ok by age 7.

2/3rds of children have an affected parent.

67
Q

How can you manage Nocturnal Enuresis?

A

You can have a star chart
Enuresis alarm

Short term desmopressin

68
Q

Bone Tumours:

What is an Ewings Sarcoma?

What is an osteosarcoma?

A

Ewings is common in the shoulder blades and hips (generally weird places)

Osteosarcoma is more common in older adolescent children. Happens in the long bones

69
Q

How do bone tumours typically present?

A

They typically present with nocturnal pain. Localised bone swelling. Swelling over the area, difficulties walking.

Systemic signs: weight loss, tiredness or night sweats

70
Q

What organism is responsible for Hand Foot and Mouth Disease?

A

Coxsackie A virus

71
Q

How does Hand foot and mouth disease present?

A

Painful itchy lesions on hand feet and mouth.

Can be systemically unwell, malaise, loss of appetite, fever etc.

Management: supportive off school until blisters heal

72
Q

What condition does Parvo virus cause?

What two groups do you have to be careful around?

A

Can cause slapped cheek syndrome

Pregnant ladies and immunocompromised individuals as can cause an aplastic crisis.

Note the patient will feel prodromally unwell as well.

73
Q

If you looked under the microscope. What would the diphtheria organism look like?

A

gram positive aerobe.

74
Q

What is the presentation of diphtheria?

A

You get a false grey membrane over the tonsils
Purlent and bloody discharge from the nose
Trouble with breathing, swallowing and talking

Generally unwell: fever, malaise and anorexia

75
Q

What is the management of diphtheria?

A

Erythromycin

Also give it to close contacts

76
Q

Are exomphalmos/gastroschisis generally diagnosed antenatally or postally?

A

Antenatally.

77
Q

Describe what exomphalmos is?
Who is it common in?
How do you treat it?

A

Protrusion of the abdominal contents through the umbilical ring. Covered by a transparent sac.

RF: include trisomy and other congenital abnormalities.

Mx: surgery

78
Q

Describe what gastroschisis is?
Who is it common in?
How do you treat it?

A

Is when you have the abdominal contents protruding adjacent to the umbilicus. No covering sac

Common in those who use alcohol or ibuprofen in pregnancy.

Treatment: cover in clingfilm and then do surgery

79
Q

What are two likely organisms to cause septic arthritis?

A

S aureus

H Influenzas

80
Q

How does septic arthritis present?

A

Erythematous, warm and tender joint

Reduced ROM and movement from the affected joint. Febrile and a limp

81
Q

How do you investigate and manage septic arthritis?

A

You investigate it with blood cultures, joint aspiration

Note joint x ray will be normal up to 7 days post infection

Management: need debridement, IV and and immobilisation.

82
Q

What tumour marker will be raised in hepatoblastoma?

A

raised alpha feet protein

83
Q

Where are brain tumours common in children?

A

Infra tectorial and posterior fossa

84
Q

What is used to stage astrocytoma brain tumours?

A

WHO grading 1-4

85
Q

What is the most common type of brain tumour?

A

Gliomas such as astrocytomas or olidgodendrogliomas.

86
Q

What is Osgood Schlatter’s Disease?

What is the pathophysiology?

A

This is a condition involving the knee

Common in adolescents.

You get multiple small avulsion fractures where the quad muscle inserts. Common in growth spurts.

87
Q

In Osgood Schlatter’s Disease what makes the pain worse (2 things)?

A

Pain is worse with exercise

Pain is worse on knee extension or against resistance

88
Q

How do you manage Osgood Schlatter’s Disease?

A

You manage it through rest, NSAIDs, physio

89
Q

What is a neuroblastoma?

What cell does it arise from?

A

Arises from the neural breast cells found in the adrenal medulla and sympathetic nervous system.

Very common under the age of 5 and very malignant.

90
Q

How does a neuroblastoma presents?

A

It presents with fatigue, anorexia and weight loss + vomiting

Abdominal mass

Periorbital bruising due to metastatic disease of the orbit. Gives raccoon eyes.

Blueberry muffin appearance due to skin mets/

bone pain causing weakness, limping and paralysis

91
Q

How do you diagnose neuroblastoma?

A

You diagnose it through CT and biopsy the lesion

92
Q

How do you manage neuroblastoma?

A

Surgical resection

Radiotherapy and Chemotherapy

93
Q

What is the inheritance pattern of osteogenesis imperfecta?

What does it affect?

A

It is an autosomal dominant inheritance condition.

It affects type 1 collage: sclera, joints, bones, tendons and teeth

94
Q

What are some of the symptoms of osteogenesis imperfecta?

A

You can get increased joint laxity

increased bone fragility. Increasing bone fractures and thus pain and deformity.

Impaired mobility

Impaired growing

Ligamentous Laxity.

95
Q

What conditions is Osteogenesis Imperfecta associated with?

A

Valvular prolapse
Hernias
Deafness
Blue appearance of the sclera

96
Q

What is the criteria used to classify Osteogenesis imperfecta?

A

The Silence Criteria

97
Q

What is the management of osteogenesis imperfecta?

A

The management is:

Bisphosphonates
Fracture splinting and also intramedullary rods may have to be placed in.

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